Sir: Sodium oxybate is increasingly being used off-label
to treat the fibromyalgia syndrome defined by pain, fatigue,
nonrefreshing sleep, and fluency loss. This compound has a
complicated mechanism of action with agonist binding on
?-aminobutyric acid (GABA)-B receptor, agonist binding on the
?-hydroxybutyrate (GHB) receptor, and possible stoichiometric
signaling effects as an intermediary in GABA and glutamate
metabolism. Its clinical effect is a profound increase in the duration
of stage III and IV slow wave sleep. This case describes
a profound effect of oxybate on bipolar disorder and tardive
dyskinesia presenting jointly with fibromyalgia.